Articles published on this blog are my opinion only, and may not necessarily reflect the views of any organisations with which I am associated. Please be aware that articles posted on this blog are not intended as a substitute for professional medical advice. If you have a medical problem relating to breastfeeding, please seek further advice from a Lactation Consultant (IBCLC) or trained Breastfeeding Counsellor.

Sunday, 27 March 2011

Introducing... the maxillary labial frenulum

Thoughts on breastfeeding with an upper labial tie

If your baby is struggling to latch properly and it's all a bit of a mystery, it might be worth checking for an upper labial tie.

Currently, there isn't much information about upper labial ties and breastfeeding, so I have done my best to piece together the research I have found in the hope that someone will find it useful. Some of the information I have included is from my own experience of feeding my own 4 children, all of whom have upper labial ties.

What is an upper labial tie?

Inside your mouth, there is a small fold of tissue which runs between your upper lip and gum (you can feel it with your tongue). This is called the maxillary labial frenulum (or frenum). Most people have no significant frenulum attachment (1), but sometimes this frenulum attaches further down the gum, or runs between the front teeth and attaches behind them, causing restricted movement of the upper lip. It's similar to tongue tie, but involving the upper lip and gum instead. An upper labial tie can occur on its own or in conjunction with a tongue tie (2). It's also possible to have a lower labial tie (involving the bottom lip and gum).

The quickest and easiest way to find out whether a baby has an upper labial tie is to lift up his upper lip and have a look!

Some babies will have a maxillary frenulum which attaches into the gum above the front teeth. This is not normally a problem, as there should still be enough upper lip mobility in order to achieve a good latch.

Some babies (mine included) will have a maxillary frenulum which attaches into the papilla (the small bump of tissue just behind the area where the upper front teeth grow) and extends into the hard palate behind the front teeth (2).

"It is very important to understand - the tightness of the frenulum can vary, and the degree of tightness can make a major difference as to any consequences."(3)

My children's dentist, Dr Chris Caldwell, has the following tip: if your baby has an upper labial tie, lift up his upper lip, stretching the frenulum. If the papilla blanches when you do this, the upper labial tie is likely to be a significant problem.

Healthcare professionals working with breastfeeding mothers and babies tell me upper labial ties are uncommon (is this simply because we aren't checking for them?). My children's dentist disagrees: they're fairly common, though they're not usually severe enough to cause major problems.

How might an upper labial tie affect breastfeeding?

Because an upper labial tie restricts movement of the upper lip, it may be difficult for the baby to latch effectively to the breast (3,4). Once latched onto the breast, the baby's upper lip may be tucked inwards, resulting in a shallow latch (5). The baby may be a 'clicky' feeder who takes in a lot of air during a feed. Breastfeeding may be painful for the mother. An older baby's upper teeth may dig into the breast during a feed, causing indentations or damage. Some babies will be able to breastfeed with an upper labial tie; others will have difficulty.The ability to breastfeed effectively depends on a range of other factors also affecting the mother (eg. breast anatomy, milk supply) and the baby (eg. oral anatomy), all of which may create further obstacles or make breastfeeding easier.

Ideas for improving the latch of a baby with an upper labial tie

If your baby has an upper labial tie and you are struggling with breastfeeding, seek help from a qualified breastfeeding specialist (such as a breastfeeding counsellor or lactation consultant).

The first step is to work on optimising the baby's latch in order to improve milk transfer: for some babies, this may be all that is needed to breastfeed successfully. In the hope that someone somewhere will find this information useful, I am sharing ways of overcoming an upper labial tie which worked for me and my babies:

A baby with an upper labial tie needs to be encouraged to accept the breast more deeply in his mouth. After much experimenting with more traditionally-taught breastfeeding holds (such as the cross-cradle hold), I initially found a variation of a technique called "exaggerated attachment" (adapted from 6) yielded some success:

Use your thumb to tilt your nipple back so it points away from the baby's nose. This makes the breast under the nipple bulge forwards.

When the baby gapes, his bottom lip and chin should come into contact with the breast first.

Using your thumb, quickly roll your nipple forward into the roof of the baby's mouth.

Then, as you take your thumb away, lift your thumb to catch the baby's upper lip and gently flick it outwards.

I've done my best to demonstrate this latching technique below (please excuse the change of holds part way through - it's hard to get good clear photos of a baby latching on!).

Although this technique helped my baby to stay on the breast, we still experienced slow weight gain, which improved after we learnt breast compressions.

Using a 'laid-back' or 'biological nurturing' position marked a major breastfeeding breakthrough for us. Catherine Watson Genna BS IBCLC suggests that "increasing head extension will allow the infant to grasp the breast sufficiently"(4) - I have noticed that this is naturally encouraged through self-attachment to the breast in a biological nurturing position. Biological nurturing, coupled with very frequent, on-demand feeds resulted in successful breastfeeding for us, despite an almost embarrassingly imperfect latch. And, as my baby grew bigger, his ability to latch vastly improved.

What if I'm considering having my baby's upper labial tie divided?

Because of the way the human face develops in the womb, an upper labial tie can occur on its own, or in conjunction with a posterior tongue tie. If your baby has an upper labial tie and you are debating whether it is the cause of any breastfeeding problems, it is worth getting someone to check for tongue tie. In some cases, dividing the tongue tie may resolve the feeding issues.

In the UK, it's not easy to find a practitioner who will divide a baby's upper labial tie. People who may be able to help you find a practitioner with the skills to divide a baby's upper labial tie include:

a Lactation Consultant (IBCLC)

the Infant Feeding Coordinator at your hospital

a paediatric dentist

a university dental school

It is worth considering that the procedure involved in dividing an upper labial tie is different to tongue tie division, and may require general anaesthetic. This really does depend on the skills of the practitioner carrying out the procedure: some will prefer to use a laser for the division; others may be more confident using a scalpel. Further information about the division of upper labial ties can be found here:

The decision to divide an upper labial tie is an individual one, based on evaluating the severity of the tie, whether it is impacting on breastfeeding, and whether it is possible to find a practitioner who will divide the tie.

What is the evidence suggesting that lip tie division is of any benefit to breastfeeding?

In addition to the websites above, I have found just one journal article suggesting that the division of an upper labial tie might benefit breastfeeding. It is a case report of one baby whose latching difficulties remained unresolved after a tongue tie division, but was able to breastfeed successfully after an upper labial tie division.

The lack of documented supporting evidence is likely a result of lack of funding to undertake research in this area, coupled with a lack of awareness that an upper labial tie can affect breastfeeding, and a lack of skills to divide an infant's labial tie. I wonder how many mothers have ended up bottle feeding as a result of an upper labial tie?

What could other impacts be of not having my baby's upper lip tie divided?

"There are no medical or dental benefits of having a tight [...] labial frenulum. There are many major medical and dental consequences that result from tight frenulums." (3) These consequences very much depend on the severity of the tie.

Apart from breastfeeding problems, an upper labial tie has been linked with:

having a gap between the two front teeth (2,4)

poor lip mobility, affecting smiling and speech (2)

increased dental decay on the upper front teeth (2)

Good dental hygiene is of particular importance for a baby with an upper labial tie. Although breastfeeding alone may not cause tooth decay, breastfeeding in conjunction with an abnormal maxillary frenulum attachment may be a contributing cause of tooth decay in a breastfeeding infant (7). This may be because the area around the upper labial tie is difficult to clean, so food particles remain trapped in the oral mucosa.

A study undertaken in 1999 found that although human breastmilk did not cause tooth decay, adding a small amount of sugar to breastmilk did cause tooth decay (8). Therefore it would be wise for children with an upper labial tie to avoid sugary foods which, in conjunction with breastmilk, might accelerate tooth decay.

There is some evidence suggesting a link between childhood tooth decay and low levels of vitamin D (9). Breastmilk is naturally low in vitamin D, so vitamin D supplementation may be a consideration for a breastfed baby with an upper labial tie.

An upper labial tie can cause dental issues later on, so even if you decide against having the procedure done in infancy, your child's dentist may suggest dividing the upper labial tie when your child is older. "Tight frenulums rarely go away by themselves (3)"; however, they can sometimes break: my eldest child accidentally tore hers on a badly-aimed dinner fork, and one of my sons fell and tore his in the skate park. My two youngest sons also have severe upper labial ties. Despite overcoming the obstacle of their upper labial ties without having them divided and breastfeeding them both successfully, I probably won't be able to help that momentary feeling of having been just a little bit short-changed if I'm told a division is necessary in future.

50 comments:

My daughter had this. Here went down between her teeth, and way up into her mouth. She had a large gap(about half an inch) between her front teeth, and was loosing weight. Her latch was painful and she was tabled families to thrive at !3 months old. (It got tighter as she grew) wevhad a referal to an ENT, and in January it was clipped. Now she has no hint of a gap, and great latch(I did have to watch her upper lip for a while, and flip it for about a week. Now its only an issue if she latched when tired) and is gaining again. She is finally 22lbs at 18 months.

Thank you so much for posting this. I recently had my 11 month old sons's 'upper lip-tie' taken care of. I saw two lactation consultants, several months apart, who missed this problem as the cause for my son's shallow, painful latch. I even carried a print off of Dr. Kotlow's article with me to one of the appointments! It is fairly easy to see if this is affecting your baby. If so, be persistent in getting the help you need. My son's latch has not improved drastically, but it is better than it was. This should have been caught much earlier...

Wow, this is just what my daughter had. Then one day I tripped while carrying her and she landed spat on her face and ripped it apart, a lot of blood but thinking about it afterwards breastfeeding was much easier and less uncomfortable. I'd always used the technique you'd suggested, I sort of developed it by myself as the best way to get her attached, after the accident she began latching on by herself. I'd never thought that the two things might be related!!

My son and I both have this, and both have a gap between our front teeth because of it. It's not severe in either of our cases -- I had no problems breastfeeding, and he had some problems, but I'm not sure how much could be blamed on the lip tie and how much on the horrible "help" I got in the hospital. He nurses fine now, at a year old. Sometimes his lip does get tucked in -- in fact, usually -- but it doesn't seem to give him trouble nursing. *shrug* I'll be more aware of this in my next children, and be sure to flip their upper lips out early on.

OMG thankyou for this article my dd has this and i only picked it up after comming across this article on fb. no health proffessionals had even checked and we have had bf probs and she has a big gap. feel so good knowing the cause but pissed it took me to discover it not her dr or midwife or early childhood nurse they obviously didnt do a very thorough dental check at her 6 month appointment as hers is quite severe thankyou

My little girl 11mths, has a severe lip tie, she is having an operation under GA in the near future. However she is currently teething hand has shown a quite sever reaction to it. There is a bout a 6mm gap between her front teeth and my theory is that this gap is shunting the other teeth along under gums and causing the extra pain. Any advice?

The only way the lip tie seemed to affect teething with my children was after their upper front teeth came through. I noticed that they would dig into my breast progressively (not biting - this is different) during a feed, leaving indentations in my skin.

It would be a good idea to voice the concerns you have with your child's dentist, who would be more qualified to help and advise you regarding dental issues arising from an upper labial tie.

I hope she's not too miserable with the teething & I hope the op goes well.

Great post! I've bookmarked it and posted the link on my FB. My younger daughter had a lip and tongue tie and saw Dr. Kotlow for treatment. She was a very pokey eater in the early days, which was probably exacerbated by my switching breasts during feedings (I have oversupply and block fed w/ my older daughter) - but when a feeding takes 45+ minutes, it's hard to stay on one breast! After the laser division (around 10 weeks), her latch was better and I started block feedings, and the BFing experience was much more pleasant and efficient.

My mother-in-law's family has the "family teeth" - gap between the front teeth, and I suspect this is due to a tie. My husband has tongue tie. Lucky daughter got both - thanks mom-in-law! LOL. I hope that with the tie divided, my daughter's adult teeth will be closer together (her baby teeth have the gap), but I suspect we'll be regulars at the orthodontist. I have noticed she rests her teeth on the breast leaving the gap-toothed dents, but older daughter also did this w/o a frenum.

Hi! I'm an IBCLC and wondering if I can have permission to use some of your information! In particular, your step by step guide, and your photos! Crediting you of course. Let me know what you think. paula.santi.lc@gmail.com

Now I'm wondering if this was one of my problems with my daughter (now 4 years old). Breastfeeding was very painful for the first 3 months - I had badly cracked nipples, she "clicked" while feeding, and multiple LLL leaders and an IBCLC couldn't figure out what the problem was. I eventually attributed it to flat nipples and oversupply making it difficult for her to latch on correctly. My son had some of the same problems (definitely flat nipples and oversupply), but without the clicking and the problems were solved a lot faster. I'll have to take a look in my daughter's mouth when she wakes up in the morning!

My son has this too... is funny I didn't know anything about it, just didn't think much about it or looking into it. Thankfully we had no problems. Anyway a week or so ago someone posted about it in a group and now I see this. Good info though so glad I saw it!

I knew nothing about this until yesterday, and it turns out my 18 month old son has a pretty severe lip tie! (It runs between his front teeth, and he won't let me look further but I would assume attaches to the palate behind the teeth.) We struggled a LOT in the early months with a painful shallow latch and clicking, which I attributed to my oversupply and strong letdown. Many of our symptoms sounded similar to tongue tie but he just does not look like he has a tongue tie at all. We both cried and screamed through a lot of nursing sessions with him refusing to latch sometimes for up to 45 minutes before finally getting so hungry he gave in and did his best. Things improved around 10-12 weeks and were ok for a few months, until his teeth started coming in and we are back to the same problems. At 18 months I'm sure he would love to nurse more, but we are down to twice a day because that's all I can tolerate of his latch, even with the above latching technique, which is pretty similar to what I eventually figured out on my own. I so wish we had had the money to see a good lactation consultant early on because we soldiered through everything on our own and it could have been so much better.

Hi Miriam,Thank you for commenting. You are not alone! I remember feeling exactly the same way when my dentist noticed my eldest 3 children all had lip ties. My 3rd child was hardest to breastfeed by quite a long way, even though 2 of my other children also have posterior tongue ties.We mothers can only ever do the best we can based on the information and support we have at the time - And you have done an amazing job of overcoming this on your own! Congratulations!!A-M

After only making it 6 weeks with my daughter (now 2.5 years old) and then having the same major issues nursing my now 8 week old son, I got very excited when he (and subsequently she) was diagnosed with an upper labial tie. And its pretty thick and very low on the gum= terrible latch and lots of pain for mom! So now we are stuck with what to do about it. ENT says wait and see and switch to formula. Dentist says it can be lasered but it may have little to no effect on the latch and I'd have to wait almost 4 weeks to find out. Decisions, decisions! Breastfeeding has been an AWFUL experience with both kids; should I wait it out and hope the procedure improves things? I'm very ready to quit like TODAY!

So sorry to hear you're having problems with feeding - I've been there! The very best thing you can do for your breastfeeding relationship is to seek out a lactation consultant (look for the letters IBCLC after their name), who will be able to check whether your baby also has a posterior tongue tie (not always obvious) and a high palate as well, which sometimes occur alongside a labial tie. They will also be able to assist you with moving forward with your breastfeeding relationship.

If your ENT is suggesting switching to infant formula, this rather suggests to me that your ENT isn't very well informed or supportive about breastfeeding and doesn't want to deal with the problem. There is no guarantee that the baby will latch well onto a bottle if he is having trouble at the breast. It might solve one problem, but create others, as I'm sure you are well aware.

Breastfeeding should be an enjoyable experience, so I really feel for you. It IS worth fighting for that enjoyable experience, so if you think the procedure would make a difference, it's well worth making some noise and getting something done about it. After all, these professionals are your hired help - if you end up losing your breastfeeding relationship because they aren't taking you seriously, they haven't done their jobs properly (to be perfectly blunt about it!).

In the meantime, I sincerely hope you find the help and support you need (please do contact a breastfeeding specialist), and are finally able to enjoy your breastfeeding relationship. I'll be thinking of you.

Thank you for posting your hard work on this site. I have sent a link through to a tongue-tie group because of your emphasis on lip-tie. Many parents struggle getting recognition and it helps to add your experiences in their battle to gain medical support.

wow, you've filled in so many pieces of my story. I completely did the 'roll in'-style latch that you described with my oldest child as he could not achieve a good latch. We I was fobbed off by my HP about his tongue tie and had not even heard of upper labial tie back then. Our youngest child also has tongue tie and upper labial tie. I had heard of biological nurturing when he was born and, for us, it made all the difference.

Fascinating and useful for my work with breastfeeding women. I had this and, though it didn't stop me breastfeeding, it did give me a big gap between my teeth. It was snipped (with local anaesthetic) when I was about 8, which solved the gap problem.Thanks!APH

Do you know where I can get it divided? DD has a small TT that was evaluated by IBCLC who said it did not need removing (she was 10 months old when seen), but after seeing this page I had a look and found she has the most severe type of labial frenulum. I'm sure she'll need it removed to correct the large gap. Is it better if done earlier (I don't think it is impacting breastfeeding)? Where can I find someone who will remove it?

i want to thank you for this information. i have never seen or heard of this before and i have done extensive research on nursing problems since my son had trouble in the beginning and was loosing weight. i was convinced that i was selfishly sleeping and neglecting feeding him properly (his doctor was no help). eventually we over came our problem on our own. although he still latches very shallowly sometimes and i feel sore in the mornings when he's been nursing all night.

i even saw a lactation consultant who couldn't help me and I eventually developed a latching technique similar to the one you picture in this blog. i questioned the way his frenulum looked very early on but my husband was convinced that it was normal and i was just reaching for things to blame his weight loss on.

now that i know this is a problem, and i think a pretty severe one although it could be worse, i'm going to take him to a pediatric dentist for a consult. i have also shared this link on my facebook and breastfeeding support forum int he hopes that someone will be helped by it *before* they go through the weeks of guilt and sobbing.

Hi anonymous,I'm afraid you haven't given me much of a clue where you live, so I can't really make a specific suggestion about who could divide the tie for you. It might be a good idea to contact the IBCLC you saw about the TT originally, as they may have contacts who can help you. Alternatively, I make some further suggestions in the article above to help you find someone with the skills to evaluate and divide the tie if necessary. I hope that helps!

I am so glad that I found this article!! I live in the U.S. and have two dd both with very thick labial frenulums. Nursing was very rough and with my first daughter I switched to formula at 2 weeks from failure to gain weight. My second daughter I had the same issues very sore/cracked nipples, 45+ feeding sessions, and still failure to gain weight. With her we had to supplement formula at 8 weeks and I ended up producing less and less until we had to switch to full time formula. I asked the lactation consultant and doctors about this and no one was familiar with it, they all said that it would not interfere with nursing. I am currently pregnant and on a mission to make this breastfeeding relationship work! I am hoping that if this baby has a thick labial frenulum we can get it cut shortly after birth if it is not a major procedure. I have contacted a couple of ENTs and they say they can do the procedure. I am just not sure if it is a quick snip or something that will be a little more in depth. The nurse at the ENT office seemed to think it would be quick. Has anyone had any experience with having it clipped right after birth? Thank you again for posting this, VERY HELPFUL!!

Thank you so much for this info! I have just heard about this today but looking at all three of my boys I've realized they all have pretty severe labial frenulums... Do you think there's a correlation between this and reflux? My boys all broke their latch quite frequently, made "clicking" noises while feeding and swallowed a ton of air - nothing made this better (eliminated dairy, chiropractic adjustments, change in latch/feeding techniques) and now I'm guessing this is the culprit. Any thoughts? Thanks so much! Such great info!

Hi Erin!It might be worth checking your boys for posterior tongue tie also? As I pointed out in the article, an upper labial tie and a tongue tie can sometimes occur together, which might help further explain your boys' latching difficulties.There's a small (but growing) group of breastfeeding professionals who believe there is a possible link between tongue tie and reflux. However, research-based evidence to prove this link is currently lacking.A-M

Wow so glad I found this article! My daughter is five weeks old and I have been wondering why her upper lip wouldn't flip out. I didn't even realize an upper labial tie was possible. However she is gaining weight well and even though she sometimes is a "clicky" feeder it is not painful for me and she continues to gain weight. Something for the moms out there to think about before correcting an upper labial tie: I have one as well. Mine is actually the worst one which is the maxillary frenulum. I was bottle fed and while I had a small gap in my teeth as a child, it went away when my permanent teeth came in and I never had any problems with speech or smiling. Just something to think about before having a procedure done on your baby!

Hi, thank you for this really useful information! I only recently found out by chance that my son (who is now 22 months) has upper labial tie while we was laughing - I can't believe I haven't noticed this before. Breastfeeding for the first 8 weeks was a real hell - cracked nipples and slow weight gain, tears + my son was very unsettled on the breast coming on and off all the time. I nearly gave up when suddenly my pain started to ease down after 8 weeks. I am still breastfeeding and it's fine now but his latch has always been very shallow. I'd like to make one comment and ask a question too:

1. I saw around 6-8 different midwives/breastfeeding consultants, 2-3 health visitors, 2 GPs and NO ONE checked if he had upper labial tie. How can this be possible?? All this pain for all these women and no one is aware of this issue. A few were aware of tongue-tie and checked my son for this but the upper lip was ignored. I don't think there is any information on this on La Leche League either and I will be writing to them too. I think checking for this and tongue tie should be part of the standard checks at the hospital once the baby is born.

2. Are you aware if there are any associated problems with eating solid foods if the child has upper labial tie?? My son is a fussy eater and I wonder if this could be a problem. He doesn't have problems with talking at all though.

Babies are not usually checked for lip ties. I think this is because few people know about them.

This is the only article I've found on the La Leche League website regarding lip ties: http://www.lalecheleague.org/nb/nbsepoct00p161.html

I am not aware of any links between lip ties and problems eating solid foods. With regard to "fussy eaters," you may find it useful to read the book "My child won't eat! How to enjoy mealtimes without worry" by Carlos Gonzalez?

Hi, thanks for recommending Gonzalez's book. I've read it now and it's fantastic. Everything makes sense and I feel better now about my son's eating. I was sort of following his method after speaking to a health visitor and there was definitely change there! He also explains really well why breastfeeding on demand is so much more suited to babies and what the disadvantages of scheduled breastfeeding are. Thank you again! I've recommended it to quite a few people now. K, London

Thank you for the info! At one-year-old, I just caught a glimpse of my baby's upper lip tie and felt so shocked that I had never noticed it before. She has always had a wimpy latch with lots of sucking sounds during breastfeeding, but after the first month her weight gain was on track, so I didn't worry about it. But now it makes so much sense! No wonder her upper lip never seemed to flair out! I feel like such a fool. Now I'm trying to find a local doctor or dentist to look at it. Thanks again.

my son is 12 months old and has a severe lip-tie as well as a tongue-tie. i felt the same way many of these other mothers have. he was bottle fed from the start but had a terrible latch, was messy and wasted more milk than he ate. he also suffered from reflux, due to all the air he was taking in. as a mother i felt something just wasnt right, but no one seemed to notice it but me. i was the one who brought attention to his tongue and lip not the pediatrician. so we were sent to an ENT who now is going to clip both. its strange that there is so much info on tongue-tie but not on the lip-tie. thanks so much for all your helpful information!

Thank you so much for this article! My daughter is 5 months old and has never been able to breastfeed effectively. We have seen lactation consultants, a speech therapist, and an ENT Dr. and not one of them checked for a lip-tie. The ENT said she had a slight tongue tie which he clipped and a slightly high palate. After I read this I called his office and scheduled an appt for ASAP and he is going to check it out. I finally feel a bit of hope after almost giving up, thank you thank you!!

Thank you for such an informative post, best post out there for information and photos. You helped me a lot when I was struggling with this issue. We had a subtle tongue-tie which getting that clipped helped bring the pain level for me from excruciating to bearable discomfort. It was still uncomfortable, the upper lip was not out and the slightest touch to my breast would break the latch. Getting the lip tie clipped was a hard choice to make, but was so worth it. I felt my let-down for the first time ever after having that procedure done. It grew back a little since we had it snipped, not lasered, but its still workable for us. I wanted to post to share my little 'clue' about the easy-to-break latch as part of how we figured out what was going on. I think he was 15 weeks when we got it taken care of.

Thank you so much for this blog. I have had terrible difficulties breastfeeding both of my children. Both have upper lip ties, and both seem to have posterior tongue ties. I say 'seem to', as it is very hard to find anyone to actually assess this properly! My son actually had his tt snipped twice but it regrew.

I managed to keep breastfeeding despite these things, but it's always been uncomfortable and both of them were really windy feeders and suffered from reflux.

My son is now 11 months - his feeding had improved but now that his teeth are through it has become quite painful for me again. I just can't get him to attach well. He doesn't open his mouth wide enough, doesn't put his tongue over his bottom teeth, and doesn't flare his top lip.

We are in the difficult position of trying to decide whether to pursue another tongue tie (and possibly a lip tie) division.

I just noticed today while my 19 month old was sleeping with her head back on my lap that her upper lip is attached to her gums, right between her teeth. Not sure how far back it goes. We never had problems breastfeeding, although I would say she was clicky, and strongly prefered certain postions. She also has no gap between her baby teeth. Does anyone know if her speech could be affected?

Do you have any recommendations for bottle brands that work best for babies with this problem? When my son goes to daycare he will need to take pumped breast milk in a bottle and currently he struggles to drink from a bottle almost as much as he does with breast feeding (which is a nightmare!)

My 2 month old has a tongue tie and lip tie and I cannot find a doctor to listen to me at all. Maybe it's because I'm stuck in Mississippi. I cannot wait until we get stationed somewhere else. I am having all kinds of BF problems.

This article is awesome...thank you:) I found this while looking for info about my 9 month old who fell and split the join in her top lip (to see if any long term issues). Turns out she had what you are discussing (and by sounds of it her accident may be a benefit). She has always fed well (luckily) and is a chubby bub but I would have to pull her top lip out sometimes during attachment and now she has top teeth I was finding that it was painful as they seemed to 'dig in' while she fed. Well now hopefully she will not have any gaps as her teeth grow through:) Thanks heaps I will definately share this site and info!

What a great article! Thank you for sharing this. I want to share it with everyone! I had a visit with a wonderful IBCLC who pointed out my son's upper lip tie. This is my fourth baby and the first I have been able to nurse 100%. My first ended up in the hospital at 5 days for dehydration. My second started formula after only two days when my nipples were cracked and bleeding and his latch looked fine. He would scream and refuse to latch, so I just couldn't handle it emotionally. My third child, I was determined to breastfeed (because the first two had formula sensitivities and vomited all the time). I ended up using the medela SNS to supplement at the breast from 2-13 months when she could drink regular milk. Her latch was always pretty terrible, though it looked fine to the lactation consultant. I always had pain, rarely felt let-down, and I did have tooth indentations on my breasts. After learning about my baby's tie, I checked the other kids and found the tie in the middle two, but I wonder if my oldest's tore. I also have evidence of a tear in mine and my mom had trouble breastfeeding me. I have gone back and forth with the idea of having anything done about this baby's tie. He is gaining well, but his latch is uncomfortable for me and he doesn't stay latched well and swallows lots of air. I am trying to stretch it out a bit, but I don't know if it will help. I hope we can somehow raise awareness of this issue. Maybe we will find it much more common that is believed, and with support more mothers will be able to overcome this obstacle to breastfeed their babies.

WoW! My 2 month old has lip tie! I never knew. Now I understand why he "clicks" and takes in air, does not have a strong latch, and I always have to flange his lip out with my fingers. Thankfully he is getting plenty of milk and gaining weight without problem. Thank you so much for this information. I am going to try the biological nurturing position.

It makes me quite upset to think that just like one of the many issues I suffered from during my nightmare pregnancy, lip tie is yet another condition that is not really recognised here in the UK. I'm really upset on behalf of myself and my 4½ month old son, and everyone else suffering as a result of this condition.

My son's tongue tie was identified and dealt with at three weeks old but not what I now understand to be his lip tie. No wonder breastfeeding is still really painful for me after 20 weeks! Also, I'm wondering if this explains his reflux. And to think: my own mother, who we're temporarily staying with, is a health visitor and has never even heard of it (or doesn't believe it's really an issue, can't tell which).

Hi! Im almost positive my son has a lip tie. Do you have an email I can send you a picture to so you can give me advice.? I'd greatly appreciate it. He's seven weeks and my nipples still are sore. He also has really bad reflux and is fussy at the breast.

Love your article, I am a lactation educator. I work with postpartum mommies and babies. Love to share this. I have also used your same idea of latching a lip tie and tongue tie baby. Its great to see your research on your post. Allow me yo share with full credit to your name? Thank you in advance.

Thank you for posting this!! I just discovered today that my 19 months old daughter has lip tie.... I am wondering why no doctor, nurse, lactation consultant saw this before !?? ! I have one breast with inverted nipple. She couldn't latch on that one. It was a nightmare... the pain, the bleeding, the pumping 15 minute of every hour for 3 days... I ended up breastfeeding her on one side only, even if it felt like I had milk in the other breast. She was always below 25% in weight, and waking up hungry at night. I tried the sleep training 3-4 times... it didn't really work. I just knew that my baby was hungry. When I supplemented with formula she vomited... I was always wondering why we cannot see her top teeth when she smiles..I will call tomorrow around and see if we can get this taken care of..Thanks again !

Thank you for such an informative post, best post out there for information and photos. You helped me a lot when I was struggling with this issue. We had a subtle tongue-tie which getting that clipped helped bring the pain level for me from excruciating to bearable discomfort. It was still uncomfortable, the upper lip was not out and the slightest touch to my breast would break the latch.

I really struggled with breast feeding my daughter when we started and we finally were able to succeed with a nipple shield. For 10 months we went like this and I had no idea why she would not latch any better then she was. We discovered when her teeth started coming in, that she had a labial lip tie. She would scream bloody murder when we tried to lift her lip to look at it. One of her pediatricians said that it had nothing to do with our nursing problems but I disagreed so I asked for a referral. I saw an ENT and made it pretty clear that I wanted it corrected.

Well my daughter (5 days from her 1st birthday) had a labial frenulectomy. I was very afraid of what would happen to our nursing relationship after surgery. When she came out of surgery, I sat down to let her latch on and she took right away (with nipple shield still) and nursed with a force I had never felt before. The last 2 days have been fantastic with nursing.

The ENT said that it was a very good thing we went ahead with this surgery when we did, because her band was "very thick". I know there is not much information out there regarding a lip tie, but because of this I have becoming an outspoken voice for it with my Lactation Consultant. She also was very grateful for your article. This is something she will now keep an eye out for if a tongue tie is not the issue.

I am so thankful that her father and I decided to pursue this surgery. Thank you again!

Thank you for the article. My son is 9 moths old now, never had weight problems but i had VERY painful nursing experience ! İ was sure i was doing everything right but still the latch was weird. His sucking was very strong and he nursed for a very prolonged time like 45 minutes each side and since it hurt like hell couldn't take it more than that so i switched sides which i knew i should't because of the formilk/hindmilk ratio, but i couldn't stand the pain. Because of switching sides at every feed for months he pooped 10-14 times per day and always with a lot of gas and froth. And i have to say i too developed your technique for estanlishing a latch. The pictures above could have been mine :) i never realized what the problem was. Sadly it took me months to link the ULT to poor latch, cause i had seen it even asked a friend if that seemed normal( she said all children have that) . By now my son is doing fine, weight gain is above normal, my breasts healed ever since we established a somewhat reasonable latch, breasfeeding continues so i don't think we need the revision right away

Love your article, I am a lactation educator. I work with postpartum mommies and babies. Love to share this. I have also used your same idea of latching a lip tie and tongue tie baby. Its great to see your research on your post. Allow me yo share with full credit to your name? Thank you in advance.